Case Manager

Vacancies

Case Manager

Function
Nursing
Facility
Life Beacon Bay Hospital
Position
Case Manager
Introduction

A vacancy exists for a Case Manager  based at Life Beacon Bay Hospital Hospital, reporting to Jennifer Villaflores, Patient Services Manager. The successful candidate will be responsible for managing the financial and clinical risks of the patient in a general ward by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalization to achieve strategic objectives.

Critical Outputs

Ensuring the maximisation of revenue by

  • Ensuring accuracy of coding
  • Ensuring the correct application and interpretation of RSRT’s
  • Participating in meetings and reporting losses to RSRT team and recommend corrective actions
  • Monitoring insurance verification and workflow processes

Ensuring effective management of quality outputs by

  • Performing quality walkabouts and implement corrective measures
  • Implementing and monitoring quality improvement programmes
  • Adhering to patient services escalation processes in order to achieve QMS targets
  • Monitoring Q-evaluator scores and implementing corrective measures
  • Investigating internal and external stakeholder complaints
  • Ensuring the adherence to customer service standards

Ensuring operational excellence by

  • Monitoring submission of accurate accounts to funders
  • Updating length of stay and level of care to funders of general ward cases and where operationally required specialised unit cases.
  • Releasing care risk targets and submission within two days of discharge
  • Ensuring the compliance to LHC policies and managing authorisations and claim submissions, rejections and delays
  • Ensuring governance and risk management by monitoring and adhering to patient services policies and procedures
  • Ensuring compliance to service level agreements with internal and external stakeholders
  • Ensuring all billing checks are closed by the relevant function areas

Ensuring effective management of relationships with internal/external stakeholders by

  • Building and maintaining relationships with internal stakeholders
  • Providing feedback and information on concerns or issues raised by internal stakeholders
  • Providing and facilitating training regarding RSRT contracts to the relevant internal stakeholders
  • Ensuring effective communication with external stakeholders
  • Managing escalated concerns from Case Managers with external stakeholders
  • Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings
Requirements
  • Nursing Qualification, preferably Professional Nurse with at least three years’ experience or Enrolled Nurse with proven case manager and clinical coding experience of at least 3 -5 years.
  • Current SANC registration
  • Knowledge of hospital patient services and case management processes
  • Knowledge and understanding of CPT & ICD coding
  • Knowledge of Funder contracts, scheme rules, exclusions and benefits
  • Understanding of private hospital industry and practices
  • Computer proficiency

                                                                               

Competencies
  • Attention to detail
  • Problem-solving, analysis and judgement
  • Resilience
  • Engaging diversity
  • Verbal & written communication skills
  • Professional and technical proficiency
  • Building relationships
  • Customer responsiveness
  • Organisational awareness
  • Influencing skills
  • Action orientation
  • Excellence orientation
  • Ethical behaviour
Contact

Tristam Hill

Email
tristam.hill@lifehealthcare.co.za
Closing date
Wednesday, June 23, 2021

 Internal applicants - Before making an application, you are requested to discuss your application with your line manager. Only shortlisted candidates will be contacted. Should you not receive any communication after 2 weeks of the closing date, kindly consider your application as unsuccessful.

External candidates will also be considered.

Explore our vacancies and find the right opportunity for you. Download the application form and email to the relevant contact person specified in the job advertisement.

Life Healthcare is an equal opportunity employer.

 


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